Kirurško liječenje raka želuca

Gastric cancer remains one of the commonest causes of cancer death worldwide. According to Croatian Cancer Registry, 1282 new patients with gastric cancer were reported in year 2003 in Croatia. Radical surgical resection is the only potentialy curable method of treatment of these patients. Since lymph node metastases occur during the early stages of disease, regional lymphadenectomy is recommended as a part of radical gastrectomy but there is no worldwide consensus about the extent of the lymphadenectomy needed to achive optimal results. Japanese surgeons first introduced radical D2 lymphadenectomy with distal splenopancreatectomy and achieved impressive long term survival results using this method. No western randomized trial showed better survival results after D2 lymphadenectomy compared to D1, but patients after D2 had significantly higher postoperative mortality and morbidity. European authors showed improved survival rates without increase in morbidity and mortality in patients treated by modified D2 operation – D2 extent lymphadenectomy without pancreaticosplenectomy. Our aim in this paper is to give a review of current surgical therapy of gastric cancer and to show postoperative results in patients operated for gastric cancer in our surgical department from year 2001 to 2005.Rak želuca još uvijek je jedan od najčešćih uzroka smrti od raka u cijelome svijetu. Prema podacima Hrvatskog registra za rak u Hrvatskoj je u 2003. godini zabilježeno 1282 novih bolesnika s rakom želuca. Radikalna kirurška resekcija za te je bolesnike jedina metoda liječenja s mogućnošću izlječenja. Kako se metastaze lifnih čvorova pojavljuju u ranim stadijima bolesti, u sklopu radikalne gastrektomije preporučuje se regionalna limfadenektomija, ali nije postignut konsenzus u cijelome svijetu o opsegu limfadenektomije koju je potrebno provesti da se postignu optimalni rezultati. Japanski su kirurzi prvi uveli radikalnu D2 limfadenektomiju s distalnom splenopankreoktomijom i primjenom te metode dugoročno postigli zavidne rezultate s obzirom na preživljenje. Nijedno randomizirano kliničko ispitivanje koje se provodilo na Zapadu nije pokazalo bolje rezultate preživljenja nakon provedene D2 limfadenektomije uspore|eno s D1, ali je nakon D2 u bolesnika zabilježena znatno veća stopa postoperacijske smrtnosti i obolijevanja. Europski autori su predočili bolju stopu preživljenja bez povećanog obolijevanja i smrtnosti u bolesnika liječenih modificiranim D2 zahvatom – D2 limfadenektomijom bez pankreatikosplenektomijom. U ovome radu nastojali smo dati pregled kirurških oblika liječenja raka želuca koji se danas primjenjuju te prikazati postoperativne rezultate u bolesnika koji su zbog raka želuca operirani na našem kirurškom odjelu od 2001. do 2005. godine

Ivan Gundulić's "Dubravka"

Cilj ovog završnog rada je intepretirati Gundulićevu Dubravku. Proučavanjem Dubravke i literature vezane uz to djelo i uz Dubrovnik i općenito karakteristike baroka može se shvatiti jedan dio onog što je Gundulić htio da ta pastorala označava. To je alegorijsko djelo koje upućuje na onovremeni Dubrovnik i njegovu borbu između vlastele i građanske klase, odnosno na neslaganje vlastele da i građani mogu sudjelovati u političkom životu. Već samim određenjem da je to pastorala nismo u potpunosti u pravu jer ona sadrži elemente i drugih književnih rodova, vrsta i žanrova pa se može smatrati i melodramom, pastoralnom igrom, tragikomedijom. Nadalje, ona govori o idiličnom svijetu pastira, pastirica, satira i satirica u kojem se trebaju oženiti najljepši pastir Miljenko i najljepša pastirica Dubravka u čast dana slobode grada. Gundulić koristi stihove koji su karakteristični za njegovo razdoblje, dvostruko rimovani dvanaesterac i osmerac, a u djelu ih mijenja prema dijalozima i monolozima i onome što se tim stihovima želi izreći. Vrijeme i mjesto radnje saznajemo na početku, a djelo sadrži i stilska izražajna sredstva te je pisana jezikom s elementima sva tri narječja

Kirurško liječenje raka želuca

Gastric cancer remains one of the commonest causes of cancer death worldwide. According to Croatian Cancer Registry, 1282 new patients with gastric cancer were reported in year 2003 in Croatia. Radical surgical resection is the only potentialy curable method of treatment of these patients. Since lymph node metastases occur during the early stages of disease, regional lymphadenectomy is recommended as a part of radical gastrectomy but there is no worldwide consensus about the extent of the lymphadenectomy needed to achive optimal results. Japanese surgeons first introduced radical D2 lymphadenectomy with distal splenopancreatectomy and achieved impressive long term survival results using this method. No western randomized trial showed better survival results after D2 lymphadenectomy compared to D1, but patients after D2 had significantly higher postoperative mortality and morbidity. European authors showed improved survival rates without increase in morbidity and mortality in patients treated by modified D2 operation – D2 extent lymphadenectomy without pancreaticosplenectomy. Our aim in this paper is to give a review of current surgical therapy of gastric cancer and to show postoperative results in patients operated for gastric cancer in our surgical department from year 2001 to 2005.Rak želuca još uvijek je jedan od najčešćih uzroka smrti od raka u cijelome svijetu. Prema podacima Hrvatskog registra za rak u Hrvatskoj je u 2003. godini zabilježeno 1282 novih bolesnika s rakom želuca. Radikalna kirurška resekcija za te je bolesnike jedina metoda liječenja s mogućnošću izlječenja. Kako se metastaze lifnih čvorova pojavljuju u ranim stadijima bolesti, u sklopu radikalne gastrektomije preporučuje se regionalna limfadenektomija, ali nije postignut konsenzus u cijelome svijetu o opsegu limfadenektomije koju je potrebno provesti da se postignu optimalni rezultati. Japanski su kirurzi prvi uveli radikalnu D2 limfadenektomiju s distalnom splenopankreoktomijom i primjenom te metode dugoročno postigli zavidne rezultate s obzirom na preživljenje. Nijedno randomizirano kliničko ispitivanje koje se provodilo na Zapadu nije pokazalo bolje rezultate preživljenja nakon provedene D2 limfadenektomije uspore|eno s D1, ali je nakon D2 u bolesnika zabilježena znatno veća stopa postoperacijske smrtnosti i obolijevanja. Europski autori su predočili bolju stopu preživljenja bez povećanog obolijevanja i smrtnosti u bolesnika liječenih modificiranim D2 zahvatom – D2 limfadenektomijom bez pankreatikosplenektomijom. U ovome radu nastojali smo dati pregled kirurških oblika liječenja raka želuca koji se danas primjenjuju te prikazati postoperativne rezultate u bolesnika koji su zbog raka želuca operirani na našem kirurškom odjelu od 2001. do 2005. godine

Analyse et développement de radar à diversité spatiale: applications à l'évitement de collisions de véhicules et au positionnement local

RÉSUMÉ En tant que dispositif d’assistance à la conduite sécuritaire de la prochaine génération d’automobiles, les radars ont suscité beaucoup d’intérêt auprès des chercheurs du domaine au cours de la dernière décennie. Désormais appelés les radars à évitement/avertissement des collisions (collision avoidance/warning), ces radars ouvrent leurs chemins pour venir en aide aux conducteurs dans les conditions climatiques difficiles ou en perte de concentration. Une autre application récente des radars est dans les systèmes de positionnement local. Dans les milieux industriels et médicaux, nous avons besoin de localiser les équipements sollicités fréquemment dont les contraintes de coût et d’encombrement limitent le nombre d’exemplaires. Par ailleurs, avec le vieillissement de la population et les besoins croissants des personnes âgées en soins médicaux, la nécessité d’un système permettant l’évaluation à distance de la position (debout, couché, tombé, …) des patients se fait sentir depuis un certain temps. Un autre exemple est la surveillance des enfants et des personnes à risque dans un endroit peuplé comme dans une foire ou sur une plage. La possibilité de pouvoir repérer les pompiers dans un immeuble en feu serait une autre application intéressante. Devant la multitude de ces applications potentielles et attrayantes dont les contextes évoluent, le système de positionnement local doit à son tour évoluer et s’adapter. Par ailleurs, il est bien connu que les radars, comme tous les systèmes de télécommunications sans fil, sont confrontés au problème d’évanouissement du signal. D’une manière générale, ce problème est dû aux propagations multi-chemins du signal. Autrement dit, les réflexions multiples du signal par les objets environnants mobiles et stationnaires se neutralisent de façon aléatoire au point d’arrivée où se trouve l’antenne réceptrice. Dans un contexte différent et pour des raisons à priori différentes, les radars subissent le même type de défaillances. Même dans un milieu dégagé et avec la visibilité directe (line of sight) sur la cible, les radars sont exposés au problème d’évanouissement du signal (power fading) dû aux changements de la surface équivalente radar (radar cross section) de la cible.----------ABSTRACT As a device enabling the safe driving of the next generation of vehicles, the radars have trigged much interest among the researchers of this field in the last decade. Recently called collision avoidance/warning radar, this type of radar can assist drivers in bad weather conditions and when driver’s concentration and attention fails. In the other hand, the utilization context of systems has evolved and will go even further in the upcoming years. In the industrial locations and medical centers, we need to locate most requested equipments. With aging society and the growing needs of elder people for medical care, a system capable of remotely sensing the patients (standing, lying down or falling) has been studied since the beginning of the new century. Other interesting example would include the surveillance of children in crowded places (beaches or amusement parks) or locating fire fighters in a building. In a context of evolving applications, the vertical local positioning system should also evolve. The most frequently used method in local positioning systems is to make use of three base stations at different places and to measure the range of the tag by each base station. Then the exact location of the tag is calculated by triangulation. In practice, a fourth base station is added for more reliability and time synchronization. In some situations like the surveillance of a beach or a building on fire, installing the third base station would be a difficult or time consuming task. Our idea is to elevate the third base station at a reasonable height. This will provide a better signal quality and more information about the target can be obtained. It is a new type of local positioning system that we call VLPS (Vertical Local Positioning System). We will examine the constraints of VLPS in the second part of this thesis. Moreover, it is well known that the radars, as well as all wireless telecommunication systems, are confronted with the problem of fading signals. Generally, this problem is due to multi-path effects of signal propagations. In other words, the multiple signal reflections by the surrounding stationary and mobile objects are randomly neutralized at the arriving point of the receiving antenna. In a different context and for apparently unlike motives, the radars are subject to the same issue. Even when the target is in the line-up site of transmitting and receiving antennas (radars), they face the same type of scintillations due to the variation of the radar cross section (RCS) of a target. Indeed, the radar cross section of the majority of targets strongly depends on the aspect angles of the receiving and transmitting antennas

Ivan Gundulić's "Dubravka"

Cilj ovog završnog rada je intepretirati Gundulićevu Dubravku. Proučavanjem Dubravke i literature vezane uz to djelo i uz Dubrovnik i općenito karakteristike baroka može se shvatiti jedan dio onog što je Gundulić htio da ta pastorala označava. To je alegorijsko djelo koje upućuje na onovremeni Dubrovnik i njegovu borbu između vlastele i građanske klase, odnosno na neslaganje vlastele da i građani mogu sudjelovati u političkom životu. Već samim određenjem da je to pastorala nismo u potpunosti u pravu jer ona sadrži elemente i drugih književnih rodova, vrsta i žanrova pa se može smatrati i melodramom, pastoralnom igrom, tragikomedijom. Nadalje, ona govori o idiličnom svijetu pastira, pastirica, satira i satirica u kojem se trebaju oženiti najljepši pastir Miljenko i najljepša pastirica Dubravka u čast dana slobode grada. Gundulić koristi stihove koji su karakteristični za njegovo razdoblje, dvostruko rimovani dvanaesterac i osmerac, a u djelu ih mijenja prema dijalozima i monolozima i onome što se tim stihovima želi izreći. Vrijeme i mjesto radnje saznajemo na početku, a djelo sadrži i stilska izražajna sredstva te je pisana jezikom s elementima sva tri narječja

Chondrichthyans evolution, diversity and senses.

This book will take you on a journey to discover the origin and diversification of the head, which evolved from a seemingly headless chordate ancestor

Naša iskustva u primjeni TachoSila® u hepatobilijarnoj kirurgiji

TachoSil® je proizvod koji se koristi u kirurškim granama medicine kao suportivna terapija. Naime, pripravak služi za poboljšanje hemostaze i pomaže boljem tkivnom prijanjanju tijekom operacijskog liječenja gdje se uobičajenim kirurškim tehnikama ne postiže zadovoljavajući rezultat. Promatrali smo vrijeme intraoperativne hemostaze te usporedivši ga s već dostupnim rezultatima o vremenu kod drugih načina hemostaze nedvojbeno dokazali prednosti TachoSila®. Na uzorku od deset bolesnika uz intraoperativnu uporabu TachoSila® srednje vrijeme hemostaze bilo je 4,2 min. (3,2 min.-7 min.). Pojava žučnog sadržaja na abdominalni dren uočena je kod samo jednog bolesnika nakon primjene TachoSila®. Cost/benefit omjer je u slučaju ove metode nedvojbeno na strani njene upotrebe u hepatobilijarnoj kirurgiji. Naši rezultati dobro koreliraju s onima naših kolega u svijetu

The role of cytology in patients undergoing pressurized intraperitoneal aerosol chemotherapy (PIPAC) treatment for peritoneal carcinomatosis.

Cytology of ascites or peritoneal washing is a routine part of staging of peritoneal metastases (PM). We aim to determine value of cytology in patients undergoing pressurized intraperitoneal aerosol chemotherapy (PIPAC). Single-center retrospective cohort study included consecutive patients having PIPAC for PM of different primary between January 2015 and January 2020. A total of 75 patients (median 63 years (IQR 51-70), 67 % female) underwent a total of 144 PIPAC. At PIPAC 1 59 % patients had positive and 41 % patients had negative cytology. Patients with negative and positive cytology only differed in terms of symptoms of ascites (16% vs. 39 % respectively, p=0.04), median ascites volume (100 vs. 0 mL, p=0.01) and median PCI (9 vs. 19, p<0.01). Among 20 patients who completed 3 PIPACs (per protocol), cytology changed in one from positive to negative, and in two from negative to positive. Median overall survival was 30.9 months in the per protocol group and 12.9 months in patients having <3 PIPACs (=0.519). Positive cytology under PIPAC treatment is more frequently encountered in patients with higher PCI and symptomatic ascites. Cytoversion was rarely observed and cytology status had no impact on treatment decisions in this cohort

Augmentation enterocystoplasty in the treatment of neurogenic bladder dysfunction

Zadaća je studije bila procijeniti efikasnost augmetacijsk cistoplastike u liječenju bolesnika s jasno definiranim neurološkim lezijama i posljedičnim neurogenim mjehurom. Kod 22 bolesnika (21 muškarac i 1 žena) učinjena je augmentacijska cistoplastika zbog neurogene disfunkcije mjehura (14 ratnih ozljeda kralježnice, 7 prometnih ozljeda kralježnice, 1 transverzalni mijelitis). Temeljna indikacija za operaciju bila je neuspješna farmakoterapija, uz intermitentnu kateterizaciju i persistentnu urinarnu inkontinenciju, s kontinuiranim oštećenjem funkcije gornjeg urinarnog trakta. U 20 bolesnika učinjena je clam ileocistoplastika, dok je u dva bolesnika učinjena augmentacija ileocekoascendensom uz kontinentnu apendikostomiju. (Mainz 1). Rezultati su procjenjivani klinički i urodinamski nakon tri mjeseca i na zadnjem followupu (9 do 18 mjeseci). Gornji urinarni trakt i renalna funkcija bili su poboljšani ili ostali stabilni u svih bolesnika, kao što je u svih acidibazni status bio normalan. Tri mjeseca postoperativno svi su bolesnici bili kontinentni po danu, dok je 9 bolesnika imalo povremene epizode noćne enureze. Na zadnjem followupu svi su bolesnici bili kontinentni dan i noć, uz povremenu samokateterizaciju svakih 4 do 6 sati. Na urodinamskom ispitivanju (3 mjeseca) funkcionalni kapacitet mjehura iznosio je 310.0±78.31 ml, što je značajno povećanje u odnosu na prijeoperativnu vrijednost od 129.55±56.01 (p<0.0001; t=8,790 unpaired t test). Na zadnjem folowupu funkcionalni je kapacitet mjehura iznosio 502.73±107.14 ml, što je značajno povećanje, kako u odnosu na prijeoperativnu vrijednost, tako i u odnosu na vrijednost kapaciteta nakon tri mjeseca (p<0.0001; t=14.478; odnosno p<0.0001; t=6.812, unpaired t test). Ovaj bi nalaz sugerirao da je potrebno određeno vrijeme (duže od tri mjeseca) da se postigne definitivni uzorak ponašanja augmentiranog mjehura. Augmentacijska je cistoplastika terapijski modalitet kojim se može postići niskotlačni rezervoar, uz veliki kapacitet mjehura, te kontinencija pomoću povremene samokateterizacije.The aim of this study was to estimate efficacy of augmentation cystoplasty in treating patients with clearly defined neurological lesions and consequent neurogenic urinary bladder. The augmentation cystoplasty was performed in 22 patients (21 male and 1 female) with neurogenic bladder dysfunction (14 war spinal cord injuries, 7 spinal cord injuries caused by car accident and 1 transverse myelitis). The augmentation cystoplasty was basically indicated in patients with severe detrusor hyperreflexia and / or poor bladder compliance and with progressive damage of the upper urinary tract despite aggressive pharmacological therapy and intermittent self-catheterization. Clam ileocystoplasty was performed in 20 patients whereas in two patients we used ileocecal segment with continent appendicistomy (Mainz 1). The first postoperative followup included clinical examination and urodynamic evaluation. It was performed 3 months postoperatively and the last followup was not performed until 18 months following surgery. The renal function as well as the upper part of urinary system showed improvement or stayed stable in all patients. An acid-base balance was normal in all of them. Three months following surgery all patients were continent daily, whereas 9 out of 22 patients experienced some episodes of nocturnal enuresis. At the moment of the last followup all 22 patients were continent during 24 hours every day with intermitent self-catheterization every 4-6 hours. Three months postoperatively urodynamic evaluation revealed significant enlargement of functional bladder capacity (310.00±78.31 ml related to preoperative volume of 129.55±56.01 ml; p<0.0001; t=8.790 unpaired t-test). The last followup showed functional bladder capacity of 502.73±107.14 ml; significant enlargement related to either preoperative capacity or capacity measured three months postoperatively (p<0-0001; t=14.478 or p<0.0001; t=6.812, unpaired t-test). These results may suggest a time (more than 3 months) neede to reach a definitive pattern of augmented bladder behavior. Augmentation cystoplasty is a therapeutic modality that should be considered a viable treatment option in selected patients with neurogenic bladder dysfunction